Method and apparatus for the management of data files

ABSTRACT

The present invention provides a network system for storage of medical records. The records are stored in a database on a server. Each record includes two main parts, namely a collection of data elements containing information of medical nature for the certain individual, and a plurality of pointers providing addresses or remote locations where reside other medical data for that particular individual. Each record also includes a data element indicative of the basic type of medical data found at the location pointed to by a particular pointer. This arrangement permits a client workstation to download the record along with the set of pointers which link the client to the remotely stored files. The identification of the basic type of information that each pointer points to allows the physician to select the ones of interest and thus avoid downloading massive amounts of data where only part of that data is needed at that time. In addition, this record structure allows statistical queries to be effected without the necessity of accessing the data behind the pointers. For instance, a query can be built based on keys, one of which is the type of data that a pointer points to. The query can thus be performed solely on the basis of the pointers and the remaining information held in the record.

FIELD OF THE INVENTION

[0001] The present invention relates to the field of informationdistribution systems. More specifically, in pertains to a device andmethod for the electronic management of data files, for instance withinthe medical and health education domains.

BACKGROUND OF THE INVENTION

[0002] The following paragraphs give definitions of terms relevant tothis document:

[0003] Client-Server: Client-server computing implies that a singleapplication is being jointly accomplished by two or more interdependentpieces of equipment, including software, hardware and interface. Theclient request information and the server provides it, with each oneassigned the portion of the job which is suitable to its capabilities.Client-server can be achieved in a local area network of personalcomputers and servers or by means of a link between a user system and alarge host such as a mainframe. Typically, a client-server environmentimplies a many to one design, whereby multiple clients can makesimultaneous requests of the server, allowing for server informationsharing between clients. A crucial aspect of Internet Protocal (IP)based technology, such as the World Wide Web (WWW), is the fact that itis a client-server application.

[0004] Intranet: An intranet is any internal network (LAN or WAN) thatsupports Internet applications - primarily web (hypertest transferprotocol), but also other applications such as FTP (file transferprotocol). Intranets are used by many companies to deliver privatecorporate information to internal users.

[0005] Local vs. Wide Area Network: A local area network (LAN) is aprivate internal communication network that is confined to a small area,such as a single building or a small cluster of buildings. It is ageneral-purpose local network that can serve a variety of devices, andis generally owned, used, and operated by a single organization. A widearea network (WAN) is similar to a LAN in that it is also acommunication network, but a WAN extends over a much broader area,interconnecting communication facilities in different parts of acountry. A WAN may also be used as a public utility.

[0006] Open System: A system with the capability to cooperate withanother system in the exchange of information and in the accomplishmentof tasks, where the two systems may be implemented very differently.Every open system must conform to a minimal set of communication andprotocol standards, as defined by the open-systems interconnection (OSI)model.

[0007] Standard Exchange Protocols: A protocol is the set of rules ofconventions governing the way in which two entities cooperate toexchange data. An example of such a protocol is the Internet Protocol(IP), a library of routines called on by various network communicationsapplications.

[0008] In the past few years, the worlds of information and technologyhave made important evolutions. We have progressed from a universalanalogical support, usually on paper, towards a theoretically universalelectronic support based on the multimedia as well as Internet Protocol(IP) based technology such as the World Wide Web (WWW), JAVA and ICQ (ISeek You). The transmission of information has also made tremendousprogress and is already, or will be soon, practically instantaneous nomatter the form of information: text, data, sound, fixed or animatedimage.

[0009] The search for information is becoming more and more similar tothe concept of navigation among diverse sources of information and evenwithin documents themselves. The concept of navigation itself impliesthe need for user accessible tools as well as some sort of structuredorganization.

[0010] Narrowing the focus, this major revolution of information systemsbrings about profound changes in the relations between academic andhospital domains, in particular everything which deals with medical:archives and databases as well as the ability to consult aggregates ofthese in a transparent way and to share in real or delayed time theinformation obtained. The number of information sources in multiplyingand the communication networks are proliferating: more and moredocumentation is available in digital form and the information highwayis rapidly expanding. Concerning medical archives and databases,questions arise as to their role of maintaining or distributinginformation. If their roles of acquiring, cataloging and maintaininginformation are to continue, they will have to give access to theavailable information on new multimedia supports as well as serve asaccess points to the information within enlarged networks (e.g. thehealthcare inforoute). These changes will add to the complexity of theirmanagement, all the while enlarging their traditional mandate.

[0011] In other words, the medical archives and databases of the futurewill not only be locally archived medical-legal clinical documents, butalso high-performance data banks of primary importance to the practiceof medicine and health care everywhere within our network, all the whileconstituting a living core dedicated to clinical and scientific researchand development.

[0012] The above described evolution of the medical file and databasesystem requires that the following two objectives be achieved;

[0013] effective navigation across multiple and diverse sources ofinformation, both local and distant, performed in a transparent way withrespect to the end user;

[0014] efficient file management allowing universal research, thetreatment of contained information, and the sharing of informationbetween system users.

[0015] Currently, in order to sore medical archives and databases,passive data accumulation for each medical facility takes place within alocal network. Unfortunately, the costs of stocking information andstoring files in a local network are quite high and the space availableis limited. There is also a well-established historical insufficiencyconcerning the ability of the local medical archive file networks torespond to the documentary and information needs of the emergency doctoror of the consultant. The medical facilities do not have access to acomplete ensemble of information sources, thus complicating emergencymedical procedures and diagnoses all the while hampering the facility'sability to give patients the most appropriate treatment.

[0016] Although the solution of combining the multiple independent localnetworks into a single integrated health network seems rather obvious,the implementation of such a concept presents certain problemsconcerning the manner in which medical data is currently recorded andtreated, at both text and image levels. First of all, each separatemedical facility may count up to hundreds of thousands of active files,some archived locally, others externally, either in an integrated or arefined form. Second of all the file organization may be different ateach facility, a huge obstacle to the merging of all files into a systemwhich supports a common format file organization. There is also theproblem of available space when considering the large volume ofinformation contained in each file and the fact that the life of aparticular medical file may approach up to twenty-five years in length.Thus volume and merging problems lead to the conclusion that it iscurrently almost impossible to combine and digitize the whole of alllocal medical records from all local networks.

[0017] Even if the merging and digitizing were possible, there is aquestion as to whether this would be desired. The data recorded in themedical files does not all have the same informational anddiscriminatory value in the long run. In fact, the data falls into threecategories: data with strict medical-legal value, data with short termclinical value and data with historical value or a biological signature.Unfortunately, the first category, data with strict medical-legal value,makes up the majority of data recorded in the file while it representsthe least valuable information for emergency doctors and consultants. Onthe other hand, the most valuable information for emergency proceduresand diagnoses, the third category, makes up a very small portion of datarecorded in the file. Therefore an integrated file management systemwhich combines all of the information currently held in archived medicalfiles would be extremely inefficient in terms of usage of space, thusimpairing the extraction of information pertinent to a particularresearch.

[0018] The background information herein clearly shows that there existsa need in the industry to provide a method for developing theinformation highway to allow for access to shared medical files in anenlarged health network and other external databases in order toincrease the number of available sources of information for doctors andconsultants.

SUMMARY OF THE INVENTION

[0019] An object of the present invention is to provide a system andmethod for electronic management of data files.

[0020] Another object of the invention is a computer readable storagemedium containing a data structure that holds information.

[0021] As embodied and broadly described herein, the invention providesa computer readable storage medium holding a data structure, said datastructure comprising at least one record associated with a certainindividual, said record including:

[0022] at least one unique identifier associated strictly with thecertain individual;

[0023] at least one pointer, said pointer using the URL addressingsystem to indicate the address of a location containing data for thecertain individual, said address being in a form such that a machine canaccess the location and import the data from the location;

[0024] at least one data field, said data field associated with saidpointer, said data field being indicative of the basic nature of thedata at the location pointed to by the said pointer.

[0025] In a preferred embodiment, the computer readable storage mediumis a database containing a large number of medical records forrespective individuals. The information in each record includes at leastone attributed identifier distinguishing one record from another one.The record also contains one or more pointers, where these pointers usethe URL addressing system in order to point to remote sites holdingfiles that contain information in digitized form pertinent to theindividual. That information may be blood tests, electrocardiogramsamong many other possibilities. Each pointer provides an address that ismachine readable to import the data residing at the target location.Associated directly with the pointer is a data field, possibly stored ina mapping table in the memory of the NDSMR server, where this data fieldcontains data indicative of the basic nature of the information held inthe file or resource to which the pointer is directed. For the purposesof this specification, the term “associated” implies that the data fieldis either in a direct one-to-one mapping relationship with the pointeror, alternatively, is integrated with the pointer address to form theactual pointer data structure. Each record may also contain a collectionof data elements that provide medical information that is intended to besorted in the record for easy retrieval. This information is typicallydata that is not likely to change during the lifetime of the individual.In a specific example, the data can include, among others, biologicaldata pertinent to the individual, for instance blood type.

[0026] In use, the database can be remotely queried to extract therecord associated with a certain individual. Typically, this operationcan be performed over a network, where a client workstation requests therecord from a server managing the database. The server will transferover the network links the record that will be displayed on the clientworkstation. The information displayed includes the collection of dataelements permitting to identify the person, as well as any medical datastored in the record, where this data is more or less of a staticnature. The operator at the workstation, typically a physician, willalso observe one or more pointers to files holding additional medicaldata. The second part of each pointer, the data part, indicates to thephysician the basic nature of the data pointed to. He can thereforeselect the pointers of interest in the global set of pointers for thatrecord and import the data through any appropriate data transferprotocol.

[0027] The arrangement allows the establishment of an electronic medicalfile system of distributed nature where the bulk of the data is held atsites remote from the central database. These remote sites are typicallythe locations where the data would be collected, such as hospitals.Accordingly, the system is very flexible as the records can bemaintained even when a patient seeks medical attention and treatment atdifferent sites. Take the example of a patient that visits Hospital Awhere an electrocardiogram is taken. The electrocardiogram is digitized,by simple optical scanning, and a file created in a local network ofHospital A. An archivist then accesses the remote database and adds anew pointer entry to the patient's record. If, at a later date, thepatient visits another hospital, say Hospital B, for the same procedure,another file is created and the appropriate entry made in the patient'sdatabase record. Thus, the bulk of the medical data is retained invarious locations, yet it can be easily accessed through the pointer'sstructure.

[0028] Although the invention is better suited for applications wherethe medical records of patients are held in a database, the sameinventive principles can also be used for applications where a singlerecord is stored in the machine readable storage medium. Such a storagemedium could be a portable memory device, of the so called “Smart Card”type. The portable memory device includes a single record, however, thedata structure is the same, namely a collection of data elements ofstatic, medical nature and at least one pointer toward a locationcontaining additional medical information. To use such a portable memorydevice, it suffices to provide a suitable reader to extract theinformation contained therein and then to process the informationaccordingly, such as by remotely accessing and importing the datapointed to by the pointer(s).

[0029] In a specific, non-limiting example of implementation, a personalcommunication system (PCS), such as a cellular phone, can be used toaccess the NDSMR database. The PCS is equipped with the samecommunication exchange protocol as that in use by the NDSMR server 300,such that a connection may be established between the PCS and the NDSMRserver 300. Accordingly, users of the NDSMR system, including patientsthat are registered with the NDSMR system as well as healthcareprofessionals, can benefit from convenient, mobile means for accessingand using the NDSMR system. Other examples of such a PCS include a webphone, a cellular notepad, an IP television screen or monitor, amongothers.

[0030] As embodied and broadly described herein, the invention alsoprovides a network server, including:

[0031] a processor;

[0032] a memory including:

[0033] a) a plurality of records associated with respective individuals,said record including:

[0034] i) at least one unique identifier associated strictly with therespective individual;

[0035] ii) at least one pointer, said pointer using the URL addressingsystem to indicate the address of a location containing data for thecertain individual, said address being in a form such that a machine canaccess the location and import the data from the location;

[0036] iii) at least one data field, said data field associated withsaid pointer, said data field being indicative of the basic nature ofthe data at the location pointed to by the said pointer.

[0037] b) a program element including individual instructions, saidprogram element implementing a functional block comprising meansresponsive to a request to transfer a particular record of saidplurality of records towards a client connected to said server through adata communication pathway for locating the particular record andtransferring the record toward the client over the data communicationpathway.

[0038] As embodied and broadly described herein, the invention alsoprovides a network system for distributed storage of records, saidnetwork system including:

[0039] a server managing a database, said database containing aplurality of records of respective individuals, each record including:

[0040] a) at least on unique identifier associated strictly with therespective individual;

[0041] b) at least one pointer, said pointer using the URL addressingsystem to indicate the address of a location containing data for thecertain individual, said address being in a form such that a machine canaccess the location and import the data from the location;

[0042] c) at least one data field, said data field associated with saidpointer, said data field being indicative of the basic nature of thedata at the location pointed to by the said pointer.

[0043] a plurality of nodes remote from said server, said nodes beingconnected to said server through data communication pathways, said nodesconstituting locations pointed to by pointers in records of saiddatabase and including machine readable storage media holding the datapointed to by pointers in record of said database.

BRIEF DESCRIPTION OF THE DRAWINGS

[0044]FIG. 1 is a block diagram of a generic client-server environment,where clients and server are linked by a local area network (LAN);

[0045]FIG. 2 is a flowchart which described the current diagnosticprocess that takes place in medical facilities;

[0046]FIG. 3 is a block diagram of the health inforoute integrated withthe Network Distributed Shared Medical Record (NDSMR) System, inaccordance with the invention;

[0047]FIG. 4 is a flowchart which describes the diagnostic process whichwill take place in medical facilities under the NDSMR System;

[0048]FIG. 5 is a block diagram of a general client-server architecture;

[0049]FIGS. 6A, 6B and 6C represents the NDSMR document layout inaccordance with a particular embodiment of this invention;

[0050]FIG. 7 is a block diagram of a server in accordance with thisinvention;

[0051]FIG. 8 is a flowchart of the program element in accordance withthis invention;

[0052]FIG. 9 is a flowchart of the updates performed by the archivistson the NDSMRs, in accordance with this invention;

[0053]FIG. 10 is a block diagram of the search engine (query) processimplemented by the NDSMR system.

DETAILED DESCRIPTION

[0054]FIG. 1 illustrates a generic client-server environment, enabled bya local area network (LAN). Client-server computing is a cooperativerelationship between one or more clients and one or more servers. Theclients 104, 106, 108, and 110 submit requests to the server 102, whichprocesses the requests and returns the results to the clients. Althoughthe processing is initiated by the client(s), both client(s) and servercooperate to successfully execute an application. Therefore, theinteraction between the client and the server processes is atransactional exchange in which the client is proactive and the serveris reactive. In addition to clients and server, the third essentialcomponent of the client-server environment is the network. Client-servercomputing is distributed computing. In other words, users, applications,and resources are distributed in response to business requirements andare linked by a single LAN 100 or by an Internet of networks.

[0055] Currently, most medical facility archives still operate on apaper based support system. However, the higher end medical facilitiesare set up with their own LAN for archiving medical files, and thecomputing system is often modeled after the client-server system shownin FIG. 1. Since each separate facility has its own LAN for archivingfiles, the accessibility to files of a particular LAN is limited to theworkstations linked to the particular LAN. FIG. 2 depicts an example ofthe current state of affairs faced by medical facilities. Assume anambulance delivers an unconscious patients to the ER at step 200. Atstep 202, the doctor makes an initial diagnosis, but needs access to thepatient's medical history in order to prevent an misdiagnosis. If thepatient is without identification of any kind, the doctor has no otherrecourse but to administer a treatment at step 208 based on a diagnosisthat is potentially inaccurate because it has been established strictlyon the patient's current medical condition, without taking into accounthis/her previous medical history. If the patient does have anidentification of some kind, it can be used to cross-reference all ofthe hospital's medical files, archived locally and/or at assignedexternal archives, at step 206. The patient's file will one be found ifthe patient was previously treated at the same hospital and already hasa file stored in the network server's database. If the file is notfound, the doctor is back to step 208. Even if the file is found, it isoften incomplete and inaccurate as it lacks the information concerningtreatment(s) administered in other medical facilities. Therefore, atstep 212 the doctor must make a final diagnosis and perform thecorresponding treatment.

[0056]FIG. 3 depicts an integrated health network embodying theprinciples of this invention. For the purpose of this specification, thework “integrated” implies the implementation of internetworkcommunication between all of the various medical facility LANs, as wellas with external sources such as the global Internet, the pharmaceuticalnetwork, on-line medical libraries and journals, among many otherpossibilities. An important component of this network is a NetworkDistributed Shared Medical Record (NDSMR) system that includes two maincomponents, a server 300 and a NDSMR database 302, with the potentialfor each LAN within the health network to be connected to the server300. Alternatively, the system may include more than one server, alloperating inter-cooperatively in order to manage the NDSMR database, aresource shared by all of the servers. Although such integrated medicalnetworks may be restricted to a particular geographical region, due todiffering medical jurisdictions within a country or between differentcountries, it is an integration hurdle which could eventually beovercome as a result of a concept of the current invention known as anindividual's biological signature, to be described in detail below. Theintegration of medical facilities could thus someday be national wide,or even international wide, thereby enlarging and improving the healthnetwork.

[0057]FIG. 4 is a flowchart depicting the improved diagnosis process asa result of the present invention. Assume that an ambulance delivers anunconscious patient to Hospital A. Also assume that the patient is anetwork user of the health network, and therefore has a personal filestored in the NDSMR database. After the doctor makes his initialdiagnosis at step 402, the patient is checked for identification.

[0058] If the patient does have identification, his/her networkvalidated or attributed identifier will be known at step 408. In themost preferred embodiment of this invention, such an identifier consistsof the patient's medical insurance number such as the one available in anumber of countries of the world, including Canada. Alternatively, theidentifier may consist of the patient's social insurance number, SmartCard, or any other network attributed identification. A Smart Card is anintegrated circuit based card containing individual specific medicalinformation, to be read from and written to by appropriate electronicmeans, and offers several implementation alternatives to the NDSMRsystem, to be described in more detail below. If the patient does nothave identification, his/her biological signature can be obtained as auniversal identifier at step 406. In the most preferred embodiment ofthis invention, such an identifier consists of a fingerprint derivedsignature. The technology needed for the implementation of system useridentification via a fingerprint derived biological signature could besoftware similar to that created by and available from delsecur, aMontreal based company. Alternatively, the identifier may consist of apatient's retinal or genetic derived signature, or any other type ofbiological signature.

[0059] At step 410 the doctor sits down at workstation 304 and logs ontothe server 300, as will be discussed below. When prompted, the doctoruses the identifier obtained at either step 406 or step 408 in order torequest the patient's NDSMR from the server 300. The record istransmitted from the NDSMR database 302 to the doctor's workstation.Once the doctor has read the pertinent medical information found in therecord, he/she can scan a list of pointers appended to the record. Aswill be further described below, these pointers represent varioussignificant medical documents (such as x-rays, surgical reports, etc.),and by their textual or visual representation allow the doctor todetermine which of the pointers refer to documents pertinent to thepatient's current medical condition. Specific to this example, thedoctor decides to step 414 that a pointer referring to the most recentelectrocardiogram taken at Hospital B would be helpful for diagnosis,and at step 416 he/she activates the corresponding pointer.Consequently, the document is downloaded over the health network fromHospital B's LAN to the doctor's workstation.

[0060]FIG. 5 is a general representation of the client-serverarchitecture that implements the NDSMR system. The system includes threemain components, notably the client 304, the server 300 and the NDSMRdatabase 302. In both client 304 and server 300, the basic software isan operating system running on the hardware platform. The platforms andthe operating systems of the client and server may differ. Indeed, a keycomponent of the NDSMR system is that through client-server computing amultitude of different types of operating systems may exist within thevarious medical facility LANs. As long as the client 304 and server 300share the same communication exchange protocols and support the sameapplications, the lower-level differences are irrelevant. It is thecommunications software which enables clients and server tointeroperate. Specific to the NDSMR system, the communication exchangeprotocol adopted will be an open, non-proprietary protocol, for instancethe Internet Protocol, a standard exchange protocol in client-servernetworking, or any other similar progressive communication exchangeprotocol.

[0061] For the purpose of this specification, the term interoperateimplies, among other things, the ability of different system users(clients) to share server information and have on-line consultations, inboth real and delayed time. Real-time computing is defined as the typeof computing in which the correctness of the system depends not only onthe logical result of the computation but also on the time at which theresults are produced. Real-time tasks therefore attempt to control orreact to events that take place in the outside world. As these eventsoccur in “real time”, a real-time task must be able to keep up with theevents with which it is concerned. On the other hand, delayed-time tasksare not at all concerned with the outside world events, delayed-timesystem correctness depending solely on the logical result of thecomputation. The benefits of real-time medical consultations in the caseof emergencies are very obvious. Take for example a doctor at Hospital Cconferring with a doctor at Hospital D that is remote form Hospital C.Both doctor's can share access to an individual's NDSMR, simultaneouslystudying the record, visible on both of their workstations, andcommunicating in real-time with each other via some sort of text, voiceor video communications link, for instance an Internet messaging window,form their workstations. The equipment necessary to allow for suchreal-time communication will not be described in detail, as there are avariety of products available on the market that could be used for thistask and that are well-known to persons skilled in the art.

[0062] The server 300 is responsible for maintaining the NDSMR database,for which purpose a database management system module is required. Avariety of different applications that make use of the database may behoused on the client machines. The operative relationship that tiesclients, such as client 304, and server 300 together is software thatenables a client to make requests to the server 300 for access to theNDSMR database 302. It is important to note that the division of workbetween a client 304 and server 300 may be allocated in a number ofways. In a preferred embodiment of this invention, the system implementscooperative processing, whereby the application processing is performedin a optimized manner by taking advantage of the strengths of bothclient and server machines and of the distribution of data. Althoughsuch a configuration is quite complex to set up and maintain, in thelong run this configuration offers greater user productivity gains andgreater network efficiency. Alternatively, the system may be implementedwith server-based processing or client-based processing. In server-basedprocessing, the most basic class of client-server configuration, theclient is mainly responsible for providing a user-friendly interface,whereas nearly all of the processing is done on the server. Inclient-server processing, virtually all of the application processing isdone at the client, with the exception of certain data validationroutines and other database logic functions that are best performed atthe server. This latter architecture is perhaps the most commonclient-server approach in current use. In the interest of clarity, theserver-based processing implementation is described in the remainder ofthis description; however, the NDSMR client-server division of work maybe any one of the options described above.

[0063]FIG. 7 is a more detailed block diagram of a preferred embodimentof the server 300, which has the responsibility of managing, sorting andsearching the NDSMR database 302. Towards this end, the server isprovided with a memory 720, high-speed processor/controllers 708, 710and 712 (assume for this example that other are three), and a high-speedinput/output (I/O) architecture. The I/O architecture consists of theinterfaces 702, 704 and 706. An internal system bus 711 interconnectsthese components, enabling data and control signals to be exchangedbetween them. The server has 6 ports, identified as port A, port B, portC, port D, port E and port F. These ports connect the server to physicallinks 1, 2 and 3, allowing data to be transported to and from variousclients within the network. In the example shown, ports A, B and C areinput ports on the physical links 1, 2 and 3, respectively, while portsD, E and F are the output ports on those same physical links. The inputports are designed to receive data from their associated physical links,while the output ports are designed to transmit data over theirassociated physical links.

[0064] The interfaces 702, 704 and 706 interconnect various input andoutput ports to the physical links 1, 2 and 3, respectively. Theirfunction is to transmit incoming data packers to the internal systembust 711 for transport to the memory 720 where they can be processed byone of the processors. On the support side, the interfaces are designedto accept data packers from the system bus 711 and impress the necessaryelectrical signals over the respective physical links so that the signaltransmission can take effect. It is not deemed necessary to discuss thisstandard operation of the interface 702, 701 and 706 in more detailbecause it is well known to those skilled in the art and is not criticalto the success of the invention.

[0065] The memory 720 contains a program element that controls theoperation of the server. That program element is comprised of individualinstructions that are executed by the controllers, as will be describedin detail below. The program element includes several functional blocksthat mange several tasks. One of those functional elements is theDatabase Management System (DBMS) 714 which provides efficient andeffective use and maintenance of the NDSMR database 302. The DBMS willnot be described in detail because it is well known to those skilled inthe technological field to which the present invention belongs.

[0066] Besides the program element, the memory also holds the usualrouting table that maps the destination addresses of incoming IP datapackets (inherent to the IP communications exchange protocol) to theserver output ports. It is not deemed necessary to discuss the structureof the routing table here because this component is not critical for thesuccess of the invention and also it would be well known to a personskilled in the technological field to which the present inventionbelongs. The memory also provides random access storage, capable ofholding data elements such as data packets that the processorsmanipulate during the execution of the program element.

[0067] Another component stored in the memory 720 is a validation table,which maps all of the registered user IDs to a corresponding passwords.The table is used to validate clients logging on to the server, forsecurity purposes. One of the characteristics of cooperative orclient-based processing is that a system feature such as suer validationwould not necessarily be exclusive to the server, but could also takeplace, in whole or in part, at the client workstation. This would removefrom the server a part or all of the burden of dealing with invalidclients, thus increasing system speed and efficiency. The identificationtable associates with each user a unique user profile that specifiespermissible operations and NDSMR accesses, in order to limit access todata held within the database. Specifically, the table is used toidentify between clients with different user privileges, for instanceclients with archivist status as opposed to basic user status. Archiviststatus accords the client with read and write status, including editingand modifying privileges, for updating the NDSMRs. User status limitsthe client to NDSMR read status only. Finally the memory 720 contains arequest queue which is a buffer memory space of the FIFO type, althoughalternative types of buffer memory space may also be used, that can holddata packets to be sent to one of the controllers for processing. Thephysical configuration of the buffer does not need to be described indetail because such a component is readily available in the marketplaceand the selection of the appropriate buffer mechanism suitable for usein the present invention is well within the reach of a person skilled inthe art.

[0068] In a most preferred embodiment of this invention, the NDSMRdatabase 302 is part of the memory 720 of the server 300, as shown inFIG. 7. In the embodiment, the NDSMR database 302 is actually on aseparate storage medium, such as a non-volatile medium interconnectedthrough a high speed data by with the memory 720 so the record set fromthe database 302 can be quickly loaded in the random access memory 720for processing. Alternatively, the collection of data which makes up theNDSMR database 302 may be stored remotely on one or a set of physicalstorage device(s), for instance a disk. In such a case, one of theserver's device drivers would be responsible for communicating directlywith the peripheral device(s) in order to access the database.

[0069]FIG. 8 provides a complete flowchart illustrating an example ofthe operation of the program element stored in the memory 720, andexecuted by any one of the processor/controllers, that regulates theoperation of the server 300, specifically its interaction with theclients as well as with the NDSMR database 302. Although the serverprogram is running at all times, if no clients are logged on to theserver then it is in an effective perpetual wait state, shown at step800. Once a client attempts to log on, control is passed to thevalidation functional bloc that is part of the program element in orderto ensure that the client is a server registered user at step 804.Validation consists simply in ensuring that the user's ID is known tothe system (exists within the validation table) and that the user knowsthe correct password associated by the system with that ID (mapped bythe validation table). If either the user's ID is not known to thesystem, or the password given is incorrect, validation will fail and theuser refused possibility of logging on to the server. This is a basicvalidation procedure that is widely used. Evidently, more complexvalidation methods can be implemented, if the level of security demandsit. Next, the server waits for a request from any of the logged onclients at step 806. When a request does occur, it arrives as a flow ofdata packets at interface 702, 704 or 706, over physical link 1, 2 or 3,respectively. At step 810, the request is stored in the request queuefound in memory 720, to await its turn for processing. The programelement next releases a request from the queue (the oldest request) toany non-busy processor. If all of the processors are occupied, therelease stop is held-up until such a time where any of the threeprocessors is available.

[0070] Once a request has been released to a processor, the programelement reaches step 814, whereby the requesting client is identified bythe identification logic stored in memory 720. The identification logicfirst reads the request data packet header in order to determine thedestination address for the response to the request, specifically theaddress of the requesting client which is read from the source field,and second assigns correct status to the client (user, archivist orother status). This status is determined by the user profile, read fromthe identification table stored in memory 720. Step 814 also includesrouting logic, whereby the routing table is accessed in the memory 720in order to determine the correct output port for transmitting adatabase response to the particular client.

[0071] At step 816, the processor must determine the search parametersspecified by the request. These parameters consist in a patient'sidentifier and/or a list of other qualifiers (for instance a particulartreatment, medical condition, age group, sex, etc). Control is passed tothe DBMS logic at step 818, at which point the search is performed onthe NDSMR database. The DBMS not only performs the search on all datacontained within the NDSMR database, but also controls access tospecific records or even portions of records within the database,ensuring that confidential data or specific confidential parts of thedata being accessed is masked when returned to the client, based on theuser profile determined at step 814. The data returned by the NDSMRdatabase search is transmitted over the pre-determined output port andto the appropriate client at step 820.

[0072] As indicated above, an aspect of the current invention is theuser-friendly interface provided at the client workstation 304. Thisinterface facilitates the user's attempts at making requests of theserver, through easy to follow prompts and an on-line knowledge systemto help the user with any questions or problems. The interface allowsthe user to perform searches or queries on the NDSMR database, usinginformation filters to simplify the extraction of pertinent data fromwhat may be hundreds of thousands of network distributed shared medicalrecords. The interface also allows the user to perform keyword-basedInternet-wide searches, transparent to the user. For example, aworkstation user could initiate an Internet search for all documentsrelating to a particular medical condition by simply inputting the nameof the medical condition as the keyword, the search results returned tothe user being a list of hypertest links to all corresponding Internetdocuments. The software used to implement this interface feature hasbeen previously created by the University of Quebec at Montreal (UQAM),and is marketed under the name of Manitou of SV3. Finally, the interfaceoffers text processing tools, necessary to the editing, publication andmerging of all data received from both the Internet and the server 300.Future variations to the NDSMR system may include a more progressiveinterface at the client workstation. Specifically, a three-dimensionalview of the human body may be available to doctors and consultantslogged on to the NDSMR server, used for making requests, medicalinquiries and searches.

[0073] The Network Distributed Shared Medical Record itself is anotherelement. The NDSMR is an evolving summary medical document for aparticular individual, integrated in the form of a network accessibledocument. By “summary”, this implies that the record does notnecessarily contain all the information currently found in local networkmedical archives. Rather it is a compendium of critical medicalinformation pertinent to a particular individual, potentially useful inthe medical diagnosis of an individual's state of health andcorresponding treatment. The NDSMR is therefore a shared minimal record,offering a common communication interface to medical facilities that maybe using incompatible information systems. It has the merit of beingable to be consulted easily, at a distance, on an emergency basis, asopposed to the current situation of files archived in a local networkbut inaccessible to any users in other networks.

[0074] In a preferred embodiment of this invention, the NDSMR includesat least one universal or network attributed identifier, distinguishingone record from another, and a dynamically updated list of biologicaldata pertinent to the individual, accessible by pointers referring tothe local network where the data is actually being stored. Thisbiological data consists of significant medical documents in anelectronic format such as laboratory tests, x-rays, surgical reports,electrographic data, etc. Alternatively, other embodiments of the NDSMRmay also include a variety of other medical information pertinent to theindividual. FIGS 6A, 6B and 6C display a possible layout of the NDSMR asa WWW document, presenting several categories of medical informationpertinent to an individual, in this example John Doe. The individual'sidentifier is indicated at the top of the record, as seen in FIG. 6A.FIGS. 6B and 6C display other categories of information, including:

[0075] administrative medical data (date of birth, home and work addressand phone number, emergency contact, regular physician, etc);

[0076] permanent biological data (blood type, genetic markings ordeficiencies, tissue antigens, etc);

[0077] significant antecedents (family medical history, personal medicalhistory, surgical history, etc.);

[0078] current medical condition (allergies, medication, etc).

[0079] The final category seen in FIG. 6C consists of the dynamicallyupdated links to other biological data. The eight pointers listed referto other medical documents pertinent to John Doe which are maintained indifferent local networks, and which can be downloaded from anothernetwork site to the client workstation by invoking the downloadingoperation embedded in the pointer, thus specifying the address of thesite (and if necessary of a particular file at that site).

[0080] In addition to the set of pointers, the NDSMR could also offeraccess to complementary external sources of information, transparent tothe workstation client. Potential sources could by pharmacy networks,medical libraries or journals, accessible to the doctor or consultantvia references within the NDSMR seen on their workstation. Assume aconsultant has downloaded John Doe's NDSMR form the server 300, and isverifying the Medication(s) used references under the Current MedicalCondition category, seen in FIGS. 6C. When the consultant invokes theMedication(s) Used reference, for instance by clicking with the computermouse on the hypertext link, the NDSMR system will automaticallygenerate user authorization in order to access an Internet publishedMedical Library that may be held on an Internet site containing thisinformation, thus allowing the consultant to look up the specificsconcerning John Doe's current medication.

[0081] In accordance with this invention, the data structure of thepointer allows the workstation user, such as a doctor or consultant, todetermine the general nature of the information to which the pointer isreferring. In other words, the doctor can tell by simply looking at thepointer whether it points to a medical document concerning a pulmonaryx-ray, an electrocardiogram, allergy tests, etc. In a preferredembodiment of this invention, the pointer representation, as seen on thescreen of the client workstation, is as seen in FIG. 6C. The textualrepresentation of the pointer indicates clearly to the user the medicaldocument or information to which the pointer points, whether it be themost recent or a previous electrocardiogram, coronarography, x-ray orbrain CT scan. Alternatively, the pointers may be of a graphicalrepresentation, small icons used to specify relevant body parts andillustrate medical treatments. The scope of this invention also includesall other variations of a pointer representation implementation whichreveals the nature of the information to which it points. Transparent tothe user is the actual address, hidden beneath the physicalrepresentation, which is the actual device needed for contacting anddownloading from various external LANs and other sources, to bediscussed in more detail below.

[0082] In short, the NDSMR record is a data structure that contains twotypes of elements, namely a collection of medical data elements aboutthe individual and one or more pointers that allow additionalinformation to be downloaded, this additional information being of amedical nature and complementing the data held in the collection ofmedical data elements. Specific to this invention, these pointers adoptthe URL (Universal Resource Locator) addressing system, allowing topoint to a specific file in a directory, where that file and thatdirectory can exist on any machine on the integrated health network andcan be served via any of several different methods, specifically theInternet technologies such as ftp, http, gopher, etc. The URL addressingsystem is well documented and very well known to those skilled in theart, and therefore will not be described in more detail.

[0083] Each pointer provides an address which may consist in the entireaddress information of the file pointed to by the pointer or in areference to the address information, where the reference may be anindex in a table that contains the address information. Associateddirectly with the pointer is a data field, possible stored in a mappingtable in the memory of the NDSMR server, where this data field containsdata indicative of the basic nature of the information held in the fileor resource to which the pointer is directed. For the purposes of thisspecification, the term “associated” implies that the data field iseither in a direct one-to-one mapping relationship with the pointer or,alternatively, is integrated with the pointer address to form the actualpointer data structure. In a very specific embodiment, the data fieldassociated with the pointer, indicative of the basic nature of theinformation pointed to, can contain codes normally used by physicians tocategorise treatment events that they have administered to patients.Those codes are normally used for remuneration purposes, however, theycan be employed here in a satisfactory manner as indicators of thenature of the medical data. Alternatively, the data field associatedwith the pointer may also contain the date and time at which the pointerwas created (enabling the display of the information at the clientworkstation to be effected in a chronological order), a textualdescription of the medical information pointed to, a brief descriptionof the status/results of the medical information pointed to, etc.

[0084] To facilitate the reading of the information associated with thepointers, namely the basic nature of the medical data, the display ofthe pointers may be organized and enhanced to enable the user to easilygrasp the meaning of the data without the necessity to refer to listscross-referencing codes with the basic nature of the medical data. Thiscan be accomplished in several ways. For instance, the pointers relatedto the same information, for instance containing the address of filesthat hold electrocardiograms, may be displayed on the client workstationin a separate window and arranged in that window in chronological order.Another possibility is to display besides each pointer an icon or textbox with the suitable data. This can be accomplished by providing theclients workstation with a table that maps the code in the pointeridentifying the basic nature of the medical data with the type ofinformation to be displayed to the user. When the NDSMR is laded fromthe remote server 300, the list of pointers is identified and scanned toextract from them the codes identifying the basic nature of the medicaldata. The codes are then cross-referenced through the table with thecorresponding information to be displayed. The information is thendisplayed on the screen of the user.

[0085] Another aspect of this invention is the update of the NDSMRs,following the creation of new medical data. This task could be effectedby a NDSMR administrator, be it a medical archivist, webmaster or someother administrative appointee, also responsible for the maintenance andregular update of a local medical information system. Taking for examplethe medical archivist, it is known that within all of the healthcareestablishments such archivists are currently responsible for ensuring agood upkeep of all local medical files, as well as for producinghospitalization summaries, and therefore are aware of all recent medicalacts and treatments performed within their medical facility. Analternative to the use of NDSMR administrators is the implementation ofautomatic NDSMR updates, a process which would involve the incorporationof some sort of intelligence system into all local medical networkinformation systems.

[0086]FIG. 9 illustrates an example of a procedure to be followed bymedical facility archivists in order to update the NDSMRs. Assume thatthe archivist within a particular medical facility receives on a regularbasis a list of recent medical acts performed at the facility, as wellas supporting documents for these acts. At Step 902, the archivistupdates the facility's local Intranet medical files and creates updatedhospitalization summaries. The archivist's next step is to log on to theNDSMR server, using a archivist assigned password, at setup 904. Theserver and its DRMS will recognize the archivist password and profileand assign privileges accordingly, as described above for steps 804 and818 of the NDSMR server program element. For each different patientappearing on the archivist's updated list, a request must be made inorder to retrieve the appropriate NDSMR. The request is made on thebasis of the particular patient's identifier, submitted to the NDSMRserver at step 906. At step 908, the NDSMR is downloaded to thearchivist's workstation, at which point the archivist is capable ofmodifying and updating certain sections of the data contained in theNDSMR, for instance to Significant Antecedents, Current MedicalCondition and Links To Other Biological Data categories as seen in FIG.6C. At step 910, the archivist refers to the updated list to update theNDSMR in order to reflect the individual's most recent and pertinentmedical information, treatments and corresponding pointers. For example,assume that one of the archivist's list entries is that Mr. John Doe hasundergone a new electrocardiogram at Hospital E. The archivist will thenchange the Most Recent Electrocardiogram reference seen in the Links ToOther Biological Data category of Mr. Doe's NDSMR to point to theHospital E local network, more particularly to the file containing thedigitized electrocardiogram.

[0087] It is important to note that in order for the NDSMR system tofunction within an extended network of LANs or local Intranets, alldocuments referred to by pointers should be archived according to aspecific nomenclature and be accessible outside of the LAN. In a mostpreferred embodiment of this invention, this specific nomenclatureconsists of that adopted by a state or national medical insurancecompany, thus ensuring record consistency and successful searches. Thepointer addresses, transparent to the user, must also have a specificstructure, to be respected by all archivists. In a most preferredembodiment of this invention, the structure of the pointer addresses,all the shield respecting the URL addressing system, consists in acombination of a local network and machine address (or domain name), apatient's identifier, and a code taken from a published manual ofmedical act codes adopted by a state or national medical insurancecompany. There do exist alternatives to the specific nomenclature andpointer structures used by the NDSMR system, and the scope of thisinvention includes all other such variations whereby consistency isassured within the system.

[0088] Yet another feature of this invention is its use as asearch/query engine. Not only can a user perform searches for or querieson NDSMRs within his/her own local Intranet, but also within externalsources. NDSMR searches and queries may be performed on two differenttypes of data, and therefore databases: nominative and non-nominative.Non-nominative medical data and databases are accessible to allauthorized users, but do not require authorization from the patientwhose personal data is being consulted. Nominative medical data anddatabases require search authorization from both the workstation client,typically a doctor or consultant, and the concerned patient, with theexception of situations where emergency medical care is required. Thesearch requester will be prompted for this authorization through theworkstation interface described above, the authorization comprising someform of password, biological signature or smart card. In the case wherea search is performed by a user without nominative search authorization,the NDSMR Database Management System (DBMS) will automatically mask anynominative data found in the database response before transmitting it tothe client workstation. In summary, the NDSMR system permits thedelay-free consultation of pertinent information found within differentlocal files and, for authorized users, offers an integrated researchmotor which allows for non-nominative research, by object or by concept,on the whole of the accessible databases.

[0089] In a specific example, a user of the NDSMR system may perform asearch of all of the non-nominative medical data and databasesaccessible via the server 300 for a particular genetic characteristic.Thus, the search results returned to the user by the NDSMR system inresponse to this query would comprise all NDSMRs, both local andexternal to the user's Intranet, containing non-nominative medical datathat shares this particular genetic characteristic. As mentioned above,all nominative data within these NDSMRs would be masked by the NDSMRDBMS before transmission of the query response to the clientworkstation. Advantageously, on a basis of such a query it may bepossible to associate one or more health problems experienced by a knownpopulation with a particular genetic characteristic shared by the knownpopulation, thus furthering medical research.

[0090]FIG. 10 displays the query usage allowed by the NDSMR system. Froma client workstation, a user may make an initial query of the server300. The server's DBMS and database logic allow the NDSMR database 302to be searched rapidly and efficiently. The database logic is whatallows the server to not only retrieve records on behalf of the clientbut also to perform searches on behalf of the client. We see in FIG. 10that an initial query returned 300 possible NDSMRs. The system allowsthe suer to send out a second, more narrow query, with a resulting 25NDSMRs returned. The system is therefore very efficient, especially formassive searches performed across all accessible databases. In a mostpreferred embodiment of this invention, the query style offered by theworkstation interface will be one of relational data searches, such asthe style currently offered by the Alta Vista (Trade mark) web browser.The query style will not be described in detail as it is very well knownto a person skilled in the art. Alternatively, many other query stylescould be incorporated into the NDSMR search engine, for instance anobject-oriented search style.

[0091] The structure of the pointers as described above, where both anaddress part and an associated data part form a pointer, allows theNDSMR system to perform searches on all of the pointers contained withinthe NDSMR database, representing medical files archived at all of thevarious local networks connected within the extended health network. Asmentioned above, the data structure of the pointers allows the nature ofthe information to which they point to be determined, either directlyfrom the data structure itself in the case where both the data part andaddress part of the pointer are integrated to form the data structure ofthe pointer, or through a one-to-one mapping between the address part ofthe pointer's data structure and the data part, possibly stored in amapping table in the memory of the NDSMR server. Consequently, medicalsearches performed on the NDSMRs will return all database recordscontaining pertinent pointer links. These links will allow the user toresearch medical data from all over the health network, currentlyimpossible but vital to progressive medical development. Thus a querycould be made to extract records based on a key relating to the basicmedical information. For example, one could extract the records of allindividuals between the age of 25-35 that have undergone a particulartherapy. This information is particularly useful in statistical studies.

[0092] As mentioned above, the use of a Smart Card as a unique networkvalidated or attributed identifier for the NDSMR system users offersseveral implementation alternatives to the system. In a specificalternative embodiment of the invention, the Smart Card can be used atthe client workstation in order to access the NDSMR database. Forexample, upon attempting to log onto the NDSMR system, the client, mostlikely a physician, will be prompted by the NDSMR system server (throughthe user-friendly interface seen at the workstation) to insert thepatient's Smart Card into the workstation's appropriate electronicmeans. These electronic means read the information contained on the cardand can extract the patient's identification. The NDSMR server's programelement then passes control to its validation functional bloc in orderto ensure that the patient is a server registered user, as describedabove. In another example, the NDSMR system server may prompt the clientworkstation user for two Smart Cards, both the physician's and thepatient's, thereby increasing the security of the system.

[0093] The Smart Card may provide more than simple user identification.In another alternative embodiment of the invention, a patient's SmartCard contains medical information specific to the patient. In oneexample, the NDSMR system includes the Smart Card as a storage mediumfor system user information, with the NDSMR database records consistingstrictly in at least one unique identifier and a dynamically updatedlist of pointers to relevant medical information located at remotelocations. In such a system, the patient's Smart Card would contain allother medical information pertinent to the individual, for instance thatshown in FIGS. 6A, 6B and 6C (minus the Links To Other Biological Data).Upon logging in to the NDSMR system with a Smart Card (or two), themedical information stored on the patient's Smart Card would appear onthe client workstation, along with the list of pointers downloaded fromthe patient's record in the NDSMR database. In another example, apatient's nominative information could all be stored on the Smart Card,with only the patient's non nominative information stored in the NDSMRdatabase along with the identifier(s) and the list of pointers. Theparticular implementation of the system would ensure that noqueries/searches performed on the NDSMR database revealed anyconfidential, nominative patient information.

[0094] A patient's Smart Card, or alternatively any other form ofportable computer readable storage medium, may also be used to store andmaintain all or a portion of the date found in the particular patient'sNDSMR, where this data may be nominative, non-nominative, static ordynamic. In such a situation, the NDSMR server offers a continuouslyavailable means of update for the Smart Card, the update consisting inreading the latest information from the NDSMR and writing it to theSmart Card via the appropriate electronic means, without changing any ofthe static or nominative data stored on the card. This implementationwould allow a physician, at a hospital external to the NDSMR system'sintegrated health network, to have access to the individual's pertinentand most recent medical information, the only requirement being that thehospital must have the appropriate electronic means to read theindividual's Smart Card. A variety of other NDSMR system implementationsalso exist, distributing the whole of the patient's medical informationbetween database records and patient Smart Cards or other such portablecomputer readable storage media, and are included within the scope ofthis invention.

[0095] In yet another example of implementation, a personalcommunication system (PCS), such as a cellular phone, can be used toaccess the NDSMR database. Other examples of such a PCS include a webphone, a cellular notepad, an ID television screen or monitor, amongothers. In this example of implementation, users of the NDSMR system,including patients that are registered with the NDSMR system as well ashealthcare professionals, can benefit from convenient, mobile means foraccessing and using the NDSMR system.

[0096] In this non-limiting example of implementation, the PCS isequipped with the same communication exchange protocol as that in use bythe NDSMR server 300, such that a connection may be established betweenthe PCS and the NDSMR server 300. This communication exchange protocolmay be the Internet Protocol, or any other similar progressivecommunication exchange protocol.

[0097] As described above, when a client attempts to log into the NDSMRsystem, the NDSMR server 300 will perform a validation procedure inorder to confirm that the client is a registered user of the NDSMRsystem. In one specific example, this validation procedure consists inthe server 300 prompting the user of the PCS for an ID and password thatare authenticated by the server 300 on a basis of the validation table.Examples of such an ID include a medical insurance number, a socialinsurance number, a Smart Card, a network attributed identifier, as wellas a digital print of the user or any other type or biologically derivedsignature.

[0098] In another specific example, the PCS provides, or itself acts as,an authentication key to uniquely identify a particular user. In thecase of a cellular phone, each cellular phone includes a microchip thatmay serve as the authentication key. For example, when the cellularphone connects to the NDSMR server 300, the microchip will append to therequest for connection a unique signature, recognizable by the server300 as being associated with a registered user of the NDSMR system.Alternatively, the authentication key may be a unique signature of themicrochip validated by a pin number, where the server 300 will promptthe user of the PCS for this pin number, or any other method of singularidentification.

[0099] In addition to an authentication key, the PCS provides the userwith a display over which the user may view medical information andquery the NDSMR system. In a specific example, the above-describeduser-friendly interface is provided by the server 300 to the display ofthe PCS, where this interface permits the PCS user to make datarequests, perform keyword-based Internet-wide searches, among otheroptions. In the case of a cellular phone, the screen of the cellularphone provides a medium over which a certain amount of information canbe displayed. Where a large amount of medical information is to berequested of the NDSMR system by the user, the cellular phone may belinked to a television monitor or to a personal or professional computerworkstation, for providing the user with a more appropriate amount ofdisplay area.

[0100] As in the case of the Smart Card, a PCS of a patient registeredwith the NDSMR system may include a memory device that contains medicalinformation specific to the patient. In one example, the NDSMR systemincludes the memory device of the PCS as a storage medium for systemuser information, with the NDSMR database records consisting strictly inat least one unique identifier and a dynamically updated list ofpointers to relevant medical information located at remote locations. Insuch a system, the patient's PCS would contain, in its memory device,all other medical information pertinent to the individual. When apatient logs in to the NDSMR system via his/her PCS, the medicalinformation stored in the patient's PCS would appear on the PCs display,along with the list of pointers downloaded from the patient's record inthe NDSMR database. In another example, a patient's nominativeinformation could all be stored in the memory device of the PCS, withonly the patient's non-nominative information stored in the NDSMRdatabase along with the identifier(s) and the list of pointers. Thisparticular implementation of the system would ensure that noqueries/searches performed on the NDSMR database revealed anyconfidential, nominative patient information.

[0101] In a specific, non-limiting example, the microchip of a cellularphone belonging to a patient registered with the NDSMR system is used asa storage medium to store and maintain all or a portion of the datafound in the particular patient's NDSMR. Where this data may benominative, non-nominative, static or dynamic. The data stored on themicrochip may be updated on a request basis where, pursuant to loggingin to the NDSMR system, a request is sent from the cellular phone to theNDSMR server for updating of the data being maintained on the microchipof the phone. Alternatively, the data stored on the microchip may beupdated automatically whenever new pertinent medical information for theparticular patient has been archived on the NDSMR server. Specifically,the NDSMR server 300 is capable to offer a continuously available meansof update to all of the cellular phone users having subscribed to such aservice either directly, through their medical insurance company orthrough a medical plan under which they are protected.

[0102] Taking the example of a cellular phone user that has subscribedto the service directly, when the server 300 is performing the automaticupdate it will read the latest medical information from the patient'sNDSMR and will transmit this data to the patient's cellular phone. Inorder to perform the data transmission, the server 300 will firstattempt to establish a connection with the patient's cellular phone.Once a connection is established, the server 300 will transfer thepertinent medical information to the microchip of the cellular phone,without changing any of the static or nominative data stored in themicrochip.

[0103] Note that, in addition to being used as a means for accessing theNDSMR system, a PCS may also be used to access any health Intranet thatprovides distributed medical information and offers to registered usersof the Intranet the possibility of connecting by means of a PCS. Such ahealth Intranet may include a summary medical record database similar tothe NDSMR database, where each summary medical record necessarilyincludes at least one universal or network attributed identifier,distinguishing one record from another, as well as medical informationpertinent to the individual associated with the record. This medicalinformation may be in the form of:

[0104] textual data;

[0105] textual data and a dynamically updated list of biological datapertinent to the individual, accessible by one or more pointersaddressing one or more remote databases where the data is actually beingstored;

[0106] textual data and multimedia information;

[0107] among other possibilities.

[0108] As in the case of the NDSMR system, the biological data that isaccessible by pointers may consist of significant medical documents inan electronic format, such as laboratory tests, x-rays, surgicalreports, electrographic data, etc.

[0109] The above detailed description of examples of implementationunder the present invention should not be read in a limitative manner asrefinements and variations are possible without departing from thespirit of the invention. The scope of the invention is defined in theappended claims and their equivalents.

I claim:
 1. A network server, comprising: a) a processor; and b) amemory including: i) a plurality of summary medical records associatedwith respective individuals, each summary medical record having: atleast one unique identifier associated with a certain individual; atleast one pointer, said pointer using a URL addressing system toindicate the address of a location containing medical data not includedin the summary medical record for the certain individual, the addressbeing in a form allowing a machine to access the location and import themedical data from the location; at least one data field, said data fieldassociated with said pointer, said data field being indicative of theparticular nature of the medical data at the location pointed to by thepointer; ii) a program element including individual instructions forexecution by said processor, said program element responsive to arequest associated with a particular summary medical record issued by aclient connected to said server through a data communication pathwayfor: 1) identifying the client and determining a user profile associatedwith the client; 2) locating the particular summary medical record; 3)when the request is a request to download the particular summary medicalrecord, transferring the particular summary medical record towards theclient over the data communication pathway on basis of the user profile;and 4) when the request is a request to update the particular summarymedical record and the user profile allows the client to perform updatesto the particular summary medical record, receiving from the clientmedical data not previously contained in the particular summary medicalrecord and incorporating it into the particular summary medical record.2. A network server as defined in claim 1 , wherein each of said summarymedical records further includes a collection of medical data elementsassociated with the certain individual.
 3. A network server as definedin claim 2 , wherein each of said summary medical records includes aplurality of pointers, one of said plurality of pointers beingindicative of an address of a first location containing medical data ofa first nature for the certain individual, another one of said pointersbeing indicative of an address of a second location containing medicaldata of a second nature for the certain individual, the second locationbeing remote from the first location.
 4. A network server as defined inclaim 3 , wherein the first and second locations are different nodes ina network.
 5. A network server as defined in claim 1 , wherein the userprofile is selected from the group consisting of User and Archivist. 6.A method for managing medical information distributed across a networksystem, said network system including: a) at least one server managing adatabase, said database containing a plurality of summary medicalrecords associated with respective individuals, each summary medicalrecord including: i) at least one unique identifier associated with acertain individual; ii) at least one pointer, said pointer using a URLaddressing system to indicate the address of a location containingmedical data not included in the summary medical record for the certainindividual, the address being in a form allowing a machine to access thelocation and import the medical data from the location; iii) at leastone data field, said data field associated with said pointer, said datafield being indicative of the particular nature of the medical data atthe location pointed to by the pointer; b) a plurality of nodes remotefrom said at least one server, said nodes being connected to said atleast one server through data communication pathways, said nodesconstituting locations pointed to by pointers in said summary medicalrecords of said database and including machine readable storage mediaholding the additional data pointed to by pointers in said summarymedical records of said database; c) when new medical data becomesavailable for a certain individual, said method comprising: i) storingthe new medical data at one of said plurality of nodes; ii) modifyingthe summary medical record associated with the certain individual toinclude a pointer to the new medical data; and iii) updating the summarymedical record associated with the certain individual to remove pointersto older medical data that is no longer pertinent to the summary medicalrecord on a basis of the new medical data.
 7. A method as defined inclaim 6 , wherein updating the summary medical record includes replacinga pointer to older medical data with the pointer to the new medicaldata.
 8. A method as defined in claim 6 , wherein the steps of modifyingand updating the summary medical record are under the control of a humanoperator.
 9. A method as defined in claim 6 , wherein each of saidsummary medical records further includes a collection of medical dataelements associated with the certain individual.
 10. A method forperforming medical information queries within a network system, saidnetwork system including: a) at least one server managing a database,said database containing a plurality of summary medical recordsassociated with respective individuals, each summary medical recordincluding: i) at least one unique identifier associated with a certainindividual; ii) at least one pointer, said pointer using a URLaddressing system to indicate the address of a location containingmedical data not included in the summary medical record for the certainindividual, the address being in a form allowing a machine to access thelocation and import the medical data from the location; iii) at leastone data field, said data field associated with said pointer, said datafield being indicative of the particular nature of the medical data atthe location pointed to by the pointer; b) a plurality of nodes remotefrom said at least one server, said nodes being connected to said atleast one server through data communication pathways, said nodesconstituting locations pointed to by pointers in said summary medicalrecords of said database and including machine readable storage mediaholding the additional data pointed to by pointers in said summarymedical records of said database; c) said method comprising: i)receiving a medical information query issued by a client connected tosaid cover through a data communication pathway; ii) identifying theclient and determining a user profile associated with the client; iii)processing the data fields associated with the pointers of said summarymedical records to extract medical information; iv) returning medicalinformation to the client on a basis of the user profile.
 11. A methodas defined in claim 10 , wherein said method comprises the step ofperforming a search on all of the medical information included in thecollection of medical data elements, for the plurality of summarymedical records stored in the database.
 12. A method as defined in claim11 , wherein said method comprises the step of performing a search onall of the non-nominative medical information included in the collectionof medical data elements, for the plurality of summary medical recordsstored in the database.
 13. A method for updating a certain individual'scomputer readable storage medium with data held in a network server, thecertain individual being connected to said server through a datacommunication pathway, said network server including: a) a processor; b)a memory including: i) a plurality of summary medical records associatedwith respective individuals, each summary medical record including: atleast one unique identifier associated with a respective individual; atleast one pointer, said pointer using a URL addressing system toindicate the address of a location containing medical data not includedin the summary medical record for the respective individual, the addressbeing in a form allowing a machine to access the location and import themedical data from the location; at least one data field, said data fieldassociated with said pointer, said data field being indicative of theparticular nature of the medical data at the location pointed to by thepointer; c) said method comprising: i) receiving a request from acertain individual to transfer a particular summary medical recordtowards the certain individual's computer readable storage medium; ii)identifying the certain individual and determining a user profileassociated with the certain individual; iii) locating the particularsummary medical record in said memory; iv) transferring the particularsummary medical record towards the certain individual's computerreadable storage medium over the data communication pathway on a basisof the user profile.
 14. A method as defined in claim 13 , wherein thecertain individual's computer readable storage medium contains a portionof the medical data stored in the summary medical record of the certainindividual.
 15. A method as defined in claim 13 , wherein the certainindividual's computer readable storage medium is a Smart Card.
 16. Amethod as defined in claim 13 , wherein the certain individual'scomputer readable storage medium is a personal communication system. 17.A method as defined in claim 13 , wherein the certain individual'scomputer readable storage medium is selected from the group consistingof a cellular phone, a web phone, a cellular notepad and an IPtelevision monitor.